Endemic Foci of the Tick-Borne Relapsing Fever Spirochete <em>Borrelia crocidurae</em> in Mali, West Africa, and the Potential for Human Infection

<div><h3>Background</h3><p>Tick-borne relapsing fever spirochetes are maintained in endemic foci that involve a diversity of small mammals and argasid ticks in the genus <em>Ornithodoros</em>. Most epidemiological studies of tick-borne relapsing fever in West Africa caused by <em>Borrelia crocidurae</em> have been conducted in Senegal. The risk for humans to acquire relapsing fever in Mali is uncertain, as only a few human cases have been identified. Given the high incidence of malaria in Mali, and the potential to confuse the clinical diagnosis of these two diseases, we initiated studies to determine if there were endemic foci of relapsing fever spirochetes that could pose a risk for human infection.</p> <h3>Methodology/Principal Findings</h3><p>We investigated 20 villages across southern Mali for the presence of relapsing fever spirochetes. Small mammals were captured, thin blood smears were examined microscopically for spirochetes, and serum samples were tested for antibodies to relapsing fever spirochetes. <em>Ornithodoros sonrai</em> ticks were collected and examined for spirochetal infection. In total, 11.0% of the 663 rodents and 14.3% of the 63 shrews tested were seropositive and 2.2% of the animals had active spirochete infections when captured. In the Bandiagara region, the prevalence of infection was higher with 35% of the animals seropositive and 10% infected. Here also <em>Ornithodoros sonrai</em> were abundant and 17.3% of 278 individual ticks tested were infected with <em>Borrelia crocidurae</em>. Fifteen isolates of <em>B. crocidurae</em> were established and characterized by multi-locus sequence typing.</p> <h3>Conclusions/Significance</h3><p>The potential for human tick-borne relapsing fever exists in many areas of southern Mali.</p>